Patient and family attitudes toward schizophrenia treatment

While each person has their own unique experiences and beliefs, this review focused on highlighting the current research on attitudes towards illness, medications, non-pharmacological treatment and psychiatric research.

This review highlighted the importance of considering both patient and family member attitudes for the treatment of schizophrenia. It discussed the involvement of family members in caring for affected loved ones, despite their subjective burden. Furthermore, it described studies showing that individuals with schizophrenia can sometimes have contradictory ideas (eg endorsing the need for continuous use of medication, yet reporting that they do not need psychiatric medication once they feel better and that they would not get sick if they stopped taking psychiatric medicine). In contrast, family members consistently report overwhelming support for the need for their loved one to take psychiatric medicine, even if they may be relatively hesitant to take medicine for their own physical ailments. The review further suggests that family members are also more aware of the risks associated with discontinuing treatment than individuals with schizophrenia. Furthermore, the review found that even when individuals with schizophrenia accept that they have a psychiatric illness, they are less likely to report symptoms and diagnoses consistent with their doctors. Such discrepancies between doctors and patients highlight the need for more open discussions about attitudes so that treatment plans can be most effective. This is particularly relevant when assessing side effect profiles of various medications. In terms of non-pharmacological treatments, the review suggests that therapy interventions with highly individualized and heterogeneous concepts of illness, etiology and a positive view regarding prognosis are most effective.

Attitudes towards depot, extended release medications and implantable medicine are also reviewed. Most studies convey a positive opinion of depot medication, although in one Australian study depots were seen as being unhelpful. Patients taking extended release formulation of psychiatric medications such as weekly fluoxetine have been reported to consider once-weekly dosing more convenient than daily dosing. Long-term delivery will be extended with the introduction of surgically implantable medicine that can provide uninterrupted access to psychiatric medication for up to one year. Results of a survey suggest that patients are almost equally split between favorably and not favorably considering such implantable medications.

With the advent of new treatments, the attitudes of patients, family members and health providers towards biomedical research can provide valuable direction for future interventions. This review found that patients, family and psychiatrists strongly support research participation due to increased hope and benefits to others that research participation provides. The data further suggested that patients may not be against clinical trials in principal, but maybe less likely to participate in placebo-controlled clinical trials. Furthermore, individuals with schizophrenia and family members offer strengths in assessing not only ethically important design elements of research in psychiatry, but also provide crucial information to guide the treatment of schizophrenia.

This work was supported in part by Stanley Medical Research Institute. The surveys and more information are available at http://stanley.med.upenn.edu/Surveys.html or scetp@bbl.med.upenn.edu